Effects of Different Learning Methods for Instrumental Activities of Daily Living in Patients With Alzheimer’s Dementia: A Pilot Study

Abstract

We examined whether errorless learning (EL) and learning by modeling (LM) were more advantageous than trial and error learning (TEL) in the acquisition of instrumental activities of daily living (IADL) in Alzheimer's dementia (AD) patients (n = 14). Using a counterbalanced within-subject design, participants performed 3 learning conditions. EL consisted of straightforward prompts before any action, LM focused on the modeling of each step of the tasks and standard TEL without cues was used as a control condition. The participants had to (re)learn 3 IADL. Repeated-measure analyses during learning and follow-up assessments were performed 1 and 3 weeks after learning. The LM and the EL procedures resulted in significantly better learning compared to TEL, with effect sizes (partial eta squared) of 0.42 and 0.35, respectively. This is the first controlled study to show that (re)learning of IADL is possible in patients with AD using an error-reduction approach.

Acquisition of an instrumental activity of daily living in patients with Korsakoff's syndrome: A comparison of trial and error and errorless learning

“…As far as we know, the learning trajectory for (re)learning an instrumental activity has never been explicitly investigated in amnesiacs. Nevertheless, as supportive figures in earlier studies on errorless instrumental activity learning in dementia suggest, errorless learning leads to faster improvement compared to a slower improvement with errors, and this finding is in line with earlier results (Dechamps et al, 2011;Lekeu, Wojtasik, Van der Linden, Salmon, 2002). It has to be noted that the instrumental task in the current experiment, but also in the aforementioned experiments in dementia, are relatively easy to perform for healthy subjects.…”

“…Our results corroborate and extend previous studies that suggest that errorless learning can be successfully applied in Korsakoff's syndrome and other patients with memory problems Kessels et al, 2005;Komatsu et al, 2000). Moreover, the results indicate a parallel to recent research on instrumental activities of daily living learning in patients with dementia by means of errorless learning (Dechamps et al, 2011). It seems to be possible to obtain reliable improvements on task performance in both dementia and Korsakoff's syndrome.…”

“…For total score comparisons, the total scores per tasks were adjusted to a 100-point scale using the following formula: performance ¼ (total score/27) x 100. A performance of 100% therefore indicated perfect actions and planning (see Dechamps et al, 2011 for more details).…”

“…In fact, recent pilot trials and case studies suggest that errorless learning techniques may have positive effects on activities of daily living in dementia compared to learning techniques with errors (Thivierge, Simard, Jean, & Grandmaison, 2008;Clare & Jones, 2008). For example, Dechamps et al (2011) showed that errorless learning was an effective method to relearn instrumental activities of daily living in Alzheimer's dementia. Errorless learning was more effective than trial and error learning during a follow-up after one and three weeks, suggesting long-lasting beneficial effects for relearning instrumental activities of daily life with errorless learning.…”

“…Moreover, we wanted to investigate whether errorless learning could more effectively support the (re)learning and maintenance of an instrumental activity of daily living in Korsakoff's syndrome than trial and error learning. Based on earlier studies in dementia (e.g., Dechamps et al, 2011) and a meta-analysis on memory-impaired individuals , we expected performance in the errorless learning condition to be superior to the trial and error condition. It would be relevant to rehabilitation of Korsakoff's syndrome patients to employ the most successful (re)learning and maintenance of an instrumental activity, since this would increase the autonomy of Korsakoff's syndrome patients.…”